NEW YORK (AP) — Jose Collado sat down at a clean white table in a sun-drenched room, sang a few bars and injected himself with heroin.
After years of shooting in streets and rooftops, he found himself in one of the first two facilities in the country where local officials allow illicit drug use to make it less deadly.
Equipped and staffed to reverse overdoses, the new, privately run “overdose centers” in New York City are a bold and controversial response to a storm of opioid overdose deaths across the country.
Proponents say the sites — also known as monitored injection sites or monitored consumption rooms — are humane, realistic responses to the deadliest drug crisis in US history. Critics see them as illegal and defeatist responses to the damage drugs are inflicting on users and communities.
For Collado, 53, the room he uses regularly is simply “a blessing.”
“They always worry about you and always take care of you,” he says.
“They make sure you don’t die,” adds his friend Steve Baez. At 45, he’s come close a few times.
In its first three months, its locations in the East Harlem and Washington Heights neighborhoods of Upper Manhattan have stopped more than 150 overdoses from about 9,500 visits — many of them repeat visits totaling about 800 people. The locations plan to expand to 24/7 service later this year.
“It’s a loving environment where people can safely use it and stay alive,” says Sam Rivera, executive director of OnPoint NYC, a nonprofit that operates the centers. “We perform for people who see too many people as expendable.”
Regulated drug consumption facilities have existed in Europe, Australia and Canada for decades. Several U.S. cities and the state of Rhode Island have approved the concept, but no authorized locations were actually operational by the time New York opened in November. The announcement comes six weeks after the US Supreme Court upheld a lower court ruling that a proposed Philadelphia location was illegal under a 1986 federal statute against operating an illicit drug use venue.
Although the case was won in Philadelphia, the US Department of Justice hinted last month that it might stop fighting such sites, saying it is evaluating them and discussing “appropriate guard rails.”
New York City’s only Republican in Congress, Rep. Nicole Malliotakis, has urged the Justice Department to shut down what she sees as “heroin shooting galleries” that only encourage drug use and diminish our quality of life.
She has proposed withdrawing federal funding from any private group, state or local government, that “operates or controls” a regulated injection site.
Another New Yorker in Congress, Democratic Rep. Carolyn Maloney, is a leading sponsor of an anti-addiction proposal that could provide money for such facilities. Organizers say the New York locations are currently run on private donations, though their parent company receives city and state funding for syringe exchanges, counseling and many other services offered alongside the consumption rooms.
Several state and city officials have adopted them. But they also fueled a December protest that drew over 100 people, including US Rep. Adriano Espaillat, a New York Democrat, to complain that drug programs in general are unfairly focused on the neighborhoods of injection sites and of whiter people , be kept away from more affluent areas.
“The safe places to eat are doing God’s work, but they’re doing it in the wrong place,” said Shawn Hill, co-founder of a neighborhood group called the Greater Harlem Coalition.
People bring their own drugs—of whatever kind—to the consumption rooms, but they’re stocked with syringes, alcohol swabs, snorting straws and other paraphernalia, and most importantly, oxygen and the opioid overdose-reversal drug naloxone.
Employees, some of whom have used illicit drugs themselves, are alert for signs of overuse or other needs, from advice on injection techniques to more complicated help.
Adrian Feliciano placed a supportive hand on the shoulder of a slumped, dejected man and encouraged him to speak to a mental health counselor on a recent afternoon – and brought one on.
“For many of our employees, providing a safe space is an introduction to services,” Feliciano, the center’s clinical and holistic care director, said afterwards.
With all the services it offers and the overdoses it has flipped, OnPoint has also reached its limits. During a 10-day span in February, two regulars died and a third lay in a coma from apparent overdoses elsewhere when the sites were closed overnight, according to senior program director Kailin See, who believes longer hours would have saved them.
According to a 2021 report compiling existing studies, no deaths have been recorded at supervised injection facilities in countries that allow it, and there is some evidence linking it to fewer overdose deaths and ambulance calls in their neighborhoods .
The Boston-based Institute for Clinical and Economic Review’s report found no link between monitored injection sites and rates of various crimes, although public drug use fell in some places.
“If you believe in harm reduction, here is harm reduction that will save you money” on ambulance trips, said Dr. David Rind, the think tank’s chief medical officer.
But for Jim Crotty, a former Drug Enforcement Administration official during the Obama and Trump administrations, the sites’ life-saving purpose comes at a high social cost.
“The goal can’t be simply to keep people alive,” said Crotty, who argues that policymakers should instead focus on expanding drug treatment. “If, like me, you believe that drug use is very destructive, then the goal must be to stop using drugs.”
For his part, Rivera emphasizes the need to stem the flow of drugs into the US, rather than blaming people in poor communities “for using the drugs that have been brought in.” OnPoint says staff regularly encourages, but doesn’t force, conversations about treatment, which many clients have tried to do.
“You have to be alive to try again,” See says.
Collado has tried quitting the drugs and has stopped intermittently during his four decades of use, he said. Like many people who use the consumption rooms, he lives on the street.
He and Baez take care of each other. They’ve helped each other solve problems, shared money when one was broke, and tried to make sure no one overdosed and died alone. The space and all that is offered with it now fulfills this last role and more.
“This is my home,” Collado said. “This is my family.”